HOWARD UNIVERSITY

Department of Radiation Therapy

Case Study: Larynx Cancer
Andrew Okhuereigbe

Case Study: Rectal Cancer

Andrew Okhuereigbe
DISCLAIMER:DO NOT identify patient name, staff name or clinical center (HIPAA). Proper
documentation of information is required.

1. General Patient Identification and brief summary of Medical History: (gender, age,
medical/social history relevant to diagnosis)
Patient is a 61-year-old gentleman who noticed hoarseness in the fall of last year. He
thought initially it was cold but in the months of October November the hoarseness
persisted. In February 2014, the patient had a biopsy that showed a left true vocal cord
lesion with well moderately differentiated squamous cell carcinoma. The patient's medical
history includes hepatomegaly with subclinical liver disease. The patient had surgery on
his left arm in 1990. The patient has no radiation therapy or chemotherapy history. The
patient was diagnosed with hypertension in July 2013 and diagnosed with subclinical liver
disease due to daily alcohol consumption in March 2014. Patients medications include
losartan/potassium 100 mg and amlodipine 2.5 mg

Social history: Patient drinks 3 to 4 drinks per day. Patient currently smokes half a pack of
cigarettes daily. Patient lives by himself. He is a police officer for the printing and
engraving department.

Case Study: Rectal Cancer

Family history: Patients father died of cancer. His mother is deceased related to
complications of diabetes mellitus and hypertension.

2. Presenting Signs/Symptoms of patient:

The patient complains of hoarseness.

3.Diagnostic Clinical Detection and Work-Up: (Imaging procedures, lab, biopsy, surgery)
In February 2014, a biopsy showed a left true vocal cord lesion with well moderately
differentiated squamous cell carcinoma

4.Diagnosis: (Histopathology, staging, grading)

The final diagnosis was T1aN0M0 well moderately differentiated squamous cell carcinoma
of the glottis.

5. Adjuvant Therapies:(Surgery, Chemotherapy, Immunotherapy)

The patient is a candidate for surgery but radiation treatment is treatment of choice because
it is an early stage glottis cancer.

6. Dose, fractionation scheme, treatment modality, beam arrangement, reduced/cone down

fields, etc.
The patient was planned for the ALPHA linear accelerator using 3D conformal imaging.
The patients treatment site is his larynx. He is being given a planned does of 200 cGy in 33
fractions daily equaling a total dose of 6600 cGy. His plan included 2 treatment fields: Rt.

Case Study: Rectal Cancer

Lat and Lt. Lat.

7. Planning Simulation/Localization Procedures: (immobilization devices, beam alignment,
anatomical borders, patient positioning, field sizes, Target volume, contrast media, skin
markers/tattoos)
The patient was positioned head first supine on the table. An orfit facemask was used to
immobilize and easily reproduce the patients position. The patients arms were by his
sides and t straps were used. A sponge was placed underneath the patients knees. AP setup
tattoos were used to ensure the patients position was straight.

8. Description of field borders in relation to bony anatomy, lymphatics (routes of spread, and
critical organs in treatment fields)
The superior border includes the upper thyroid notch. The inferior border includes the cricoid
cartilage. The anterior border includes a 1 to 1.5 cm shine over (flash) over the skin surface at the
level of the vocal cords. The posterior border is just anterior to the vertebral body, including the
anterior portion of the posterior pharyngeal wall. Glottis legions are not aggressive and cervical
lymph node involvement is not present.

9. Treatment Unit Information: The patient will be treated using- (treatment type, IMRT, SRS,
number of ports, beam energy, beam alignment, treatment/gantry angles, beam modifying
devices, couch angles)

Case Study: Rectal Cancer

Field
Name

Machine

Energy

Gantry
Angle

Collimato
r Angle

Couch
Angle

Planned
Actual
SSD (cm) SSD (cm)

RT. LAT

ALPHA

10X

270

84

93.7

93.7

LT. LAT

ALPHA

10X

90

96

94.4

94.3

10. Explanation of treatment rationale for planning and field verification techniques:
The treatment of small fields for early glottic cancers rarely result in severe complications.
Large, fixed regions need more aggressive therapy. T3 and T4 lesions of the glottis and
subglottis are treated as supraglottic lesions. The radiation port borders can be clinically
determined before simulation, but CT scans and a contour of the neck are used for
computerized treatment planning.

11. Organs At Risk (OARs) and Tolerance Doses:

Special Organs in Head and Neck Region

TD 5/5 (cGy)

ORAL CAVITY

6000

SPINAL CORD

4500

LENS OF EYE

500

BRAIN

6000

RETINA

5500

CORNEA

5000

EAR

5000

Case Study: Rectal Cancer

12.Acute and Chronic Possible Radiation Side Effects/Complications and Patient Education
Strategies for prevention, healing, and comfort:
Acute side effects include temporary fatigue, skin changes, sore throat, difficulty swallowing, dry
mouth, thick saliva, voice changes, loss of appetite, and loss of taste. Chronic side effects may
include hair loss, and difficulty breathing.

13.CriticalThinking: Reflection of your interactions with the patient/family, clinical

instructor(s),issues and concerns:
The patient eager to undergo treatment when he was informed it could help his hoarseness.
Because laryngeal carcinomas display an extremely high etiology towards smoking, the
patient's excessive smoking might contribute to his diagnosis. The patient's excessive
drinking also does not help the situation. Carcinoma of the glottis is not considered life
threatening and radiation therapy can help preserve the patient's speech and maintain the
patient's airway function.

14. Proper citation of references using APA format.

Leaver, D., & Washington, C.(2009).Head and Neck Cancers :Principles and Practice of
Radiation Therapy, 730.